Application for Variation/Transfer of a Special Treatment Licence

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Kristian Sanders
8 years ago
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1 a Spec Treatment Licence Application for Variation/Transfer of a Special Treatment Licence Premises details: Ref Please accept this as notification that I wish to transfer my existing licence to the following applicant(s) Signed Dated APPLICANT(S) DETAILS Full name of the applicant: (Mr, Mrs, Ms) Full name of the applicant: (Mr, Mrs, Ms) Only complete this section if the application is made by or on behalf of a Company, Society, Body or Association. Full name of the applicant: (Mr, Mrs, Ms) The address of the registered or principal office: Private address of applicant:

applicant: (Mr, Mrs, Ms) Full name of the applicant: (Mr, Mrs, Ms) Only complete this section if the application is made by or on behalf of a

2 Management Full name of the manager: (Mr, Mrs, Ms) Full name of the manager: (Mr, Mrs, Ms) Company/Society/Body/Association Full name of applicant: (Mr, Mrs, Ms) The address of the registered or principal office: Private address of applicant: Full name of applicant: (Mr, Mrs, Ms) The address of the registered or principal office: Private address of applicant: CTITIONERS

registered or principal office: Private address of applicant: Full name of applicant: (Mr,

3 Practitioners Please list the full name and relevant technical qualifications of all the practitioner(s) who will carry out special treatments, and say which treatment(s) each person will give. Please enclose copies of qualification certificates of each new person who is to provide treatment. Please write the address of the premises on the copies. Please continue on a separate sheet if necessary. If you want to offer massage, please distinguish between full body, head and neck or foot massage.

Please enclose copies of qualification certificates of each new person who is to provide treatment.

4 Fees 1 st May Treatment Band A - low risk and non-invasive treatments, including manicure, nail extensions, pedicure, ear & nose piercing using a single pierce gun designed for the purpose, steam facials and facials combined with a facial massage. Thermal Auricular Therapy (Hopi Ear Candles) if carried out with a facial massage. Band B medium risk non-invasive treatments, including electrical treatments (high frequency, faradism, micro-current, ultra-sonic), light treatments (Infra red), head, neck & below the knee massage (Indian head massage, reflexology). Band C - higher risk or invasive treatments, including body massage (sports/remedial massage, aromatherapy, holistic massage, shiatsu, thai, stone therapy) other than described in Band B, electrolysis, acupuncture, moxibustion, spas, saunas, steam rooms, tattooing, tattoo removal, semi-permanent make-up, body piercing, sunbeds and laser/intense light pulse light treatments Licence Fee Licence Renewal Variation * Transfer ** Additional fee for laser and intense pulsed light (IPL) treatments (Please note that this list is not exclusive of all treatments) Please make cheques payable to London Borough of Barnet. If in doubt about the correct fee, please contact us for assistance.

Band B medium risk non-invasive treatments, including electrical treatments (high frequency, faradism, micro-current, ultra-sonic), light treatments (Infra red), head, neck & below the knee massage

5 If there is more than one treatment, the treatment that falls in the highest band determines the fee. Only one fee is payable however many different treatments are offered, unless Laser or IPL treatments are included, in which case the Laser/IPL fee, i.e. 69 is added to the Band C fee. If only laser/ipl treatment is offered, them Band C together with the Laser/IPL fee will apply. If at a later date you wish to offer other special treatments, employ other practitioners, or make any material change to the premises or the way in which the treatments are given, you will need to apply for a licence variation before doing so. A variation is any single material change, such as an additional treatment, a new practitioner or a significant change to the premises layout. A variation fee is charged for each separate variation. In addition to the basic variation fee(s), if the variation is to a higher band, for example from Band B to Band C, an additional fee will be payable. This is calculated as follows: Take the difference between the licence fees for the two bands, multiply by the number of complete months still to run on the existing licence, and divide by 12. For example, adding a Laser/IPL (Band C) to a licence for electrical treatments (Band B) 9 months before expiry. Band C ( 418) minus Band B ( 315) = 103. Multiply by 9 = 927. Divide by 12 = Add to the Band B variation fee ( 75) = Plus additional fee for Laser/IPL ( 69) The variation fee in this example is **A transfer is a change to a different licence holder, with no other material change. If there are other changes, variation fee(s) will be charged in addition to the transfer. If there are a number of changes, we may deem the licence to be a new one, for which the single new licence fee is charged. If you have any queries please contact Environmental Health on

If only laser/ipl treatment is offered, them Band C together with the Laser/IPL fee will apply.

6 Documents To Be Enclosed Copies of qualification certificates for each new practitioner Payment for the application I/we enclose a cheque for.... (see fees list for correct amount) I/We declare that the above particulars are true in every respect The Council may revoke or refuse to grant any licence where the applicant has knowingly given false information or omitted relevant details on their application form. Signature (or signatures in case of a partnership) Signature.. PRINT NAME. Date Signature.. PRINT NAME. Date Signature.. PRINT NAME. Date In the case of a limited liability company, the managing director or secretary should sign. Please return the fully completed application to Environmental Health, North London Business Park, Oakleigh Road South, London N11 1NP.

given false information or omitted relevant details on their application form. Signature (or signatures in case of a partnership) Signature.. PRINT NAME.

New special treatment licence application pack

New special treatment licence application pack This pack contains: Licence application form Fees list Window advertisement (all new applications) Our policy Regulations and licence conditions Information